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Objectives: To evaluate the occurrence of coring after needle insertion through the rubber stopper of prednisolone acetate vials. Methods: Two-hundred vials of prednisolone acetate were randomly distributed to two radiologists. Prednisolone acetate was drawn up through the rubber bung of the vials with an 18-gauge cutting bevelled needle and aspirated with a 5-ml syringe. The presence of coring was noted visually. We systematically put each core in a syringe refilled with 3 ml prednisolone acetate, and injected the medication through a 20-gauge spine needle. Computed tomography was performed to measure the size of each coring. Results: Coring occurred in 21 out of 200 samples (10.5 %), and was visually detected in the syringe filled up with prednisolone in 11 of the 21 cases. Ten more occult cores were detected only after the syringes and needles were taken apart and rinsed. The core size ranged from 0.6 to 1.1 mm, and 1 of the 21 (4.7 %) cores was ejected through the 20-gauge needle. Conclusion: Coring can occur after the insertion of a needle through the rubber stopper of a vial of prednisolone acetate, and the resultant core can then be aspirated into the syringe. Key Points: • Coring occurs after needle insertion through rubber stoppers of prednisolone acetate vials • Cores within a syringe filled with prednisolone acetate may be undetected • The frequency of coring during the administration of prednisolone acetate is underestimated [ABSTRACT FROM AUTHOR]

We investigated effects of high intensity focused ultrasound (HIFU) combined with contrast agent SonoVue on rabbit VX2 liver tumors by using conventional gray-scale ultrasonography (US), color/power Doppler (CD/PD) US, contrast-enhanced color Doppler (CE CD) US, and contrast-enhanced pulse-inversion harmonic (CE PIH) US. Fourteen days after implantation of VX2 tumors in livers of 50 rabbits, animals were randomly separated into two groups. Based on principles of HIFU, the volume of the tumor was divided into several parallel “planes” to be ablated. Before ablation on each “plane,” 0.2 mL SonoVue was injected in bolus via ear veins of rabbits in group II and normal saline solution was administrated in group I. Conventional gray-scale US, CD US, PD US, CE CD US, and CE PIH US were performed before and after ablation. Twenty-three surviving rabbits in each group underwent HIFU ablation. Conventional gray-scale US showed ablated areas diffusely hyperechoic. On CE PIH US, coagulated areas presented perfusion defect. Both conventional gray-scale US and CE PIH US showed the ablated volume in group II was larger than that in group I. CD US and PD US demonstrated residual vessels in periphery ablated areas in group I, but no residual vessels in group II. CE CD US and CE PIH US depicted less residual vessels in periphery ablated areas in group II than that in group I. By enlarging ablated volume of tissue and reducing residual vessels, effects of HIFU ablation on rabbit VX2 liver tumors were enhanced by contrast agent SonoVue. [ABSTRACT FROM AUTHOR]

Aims: In this article we present our experience with radiofrequency ablation (RFA) in the treatment of 105 renal tumors. Materials and Methods: RFA was performed on 105 renal tumors in 97 patients, with a mean tumor size of 32 mm (11-68 mm). The mean patient age was 71.7 years (range, 36-89 years). The ablations were carried out under ultrasound (n = 43) or CT (n = 62) guidance. Imaging follow-up was by contrast-enhanced CT within 10 days and then at 6-monthly intervals. Multivariate analysis was performed to determine variables associated with procedural outcome. Results: Eighty-three tumors were completely treated at a single sitting (79%). Twelve of the remaining tumors were successfully re-treated and a clinical decision was made not to re-treat seven patients. A patient with a small residual crescent of tumor is under follow-up and may require further treatment. In another patient, re-treatment was abandoned due to complicating pneumothorax and difficult access. One patient is awaiting further re-treatment. The overall technical success rate was 90.5%. Multivariate analysis revealed tumor size to be the only significant variable affecting procedural outcome. (p = 0.007, Pearson chi(2)) Five patients had complications. There have been no local recurrences. Conclusion: Our experience to date suggests that RFA is a safe and effective, minimally invasive treatment for small renal tumors. [ABSTRACT FROM AUTHOR]

In this study, magnetic resonance (MR) imaging findings of patients with varying stages of cervical carcinoma are reviewed. The appearances of the postirradiation pelvis on MR images are also characterized and correlated with preradiation therapy staging. MR imaging findings of recurrent and metastatic disease are presented and discussed. [ABSTRACT FROM AUTHOR]

Venous malformations (VMs) are non proliferative lesions that consist of dysplastic venous channels. The aim of imaging is to characterise the lesion and define its anatomic extent. We will describe the plain film, ultrasound (US) (including colour and duplex Doppler), computed tomography (CT), magnetic resonance imaging (MRI), conventional angiographic and direct phlebographic appearances of venous malformations. They will be illustrated at a number of head and neck locations, including orbit, oral cavity, superficial and deep facial space, supraglottic and intramuscular. An understanding of the classification of such vascular anomalies is required to define the correct therapeutic procedure to employ. Image-guided sclerotherapy alone or in combination with surgery is now the first line treatment option in many cases of head and neck venous malformations, so the radiologist is now an integral part of the multidisciplinary management team. [ABSTRACT FROM AUTHOR]

Purpose: To determine whether uterine fibroid embolization (UFE) with polyvinyl alcohol (PVA) particles affects fertility in women desiring future pregnancy. Methods: Of 288 patients managed with UFE with PVA particles for uterine myoma or adenomyosis between 1998 and 2001, 94 patients were enrolled in this study. The age range of participants was 20-40 years. The data were collected through review of medical records and telephone interviews. Mean duration of follow-up duration was 35 months (range 22-60 months). Patients using contraception and single women were excluded, and the chance of infertility caused by possible spousal infertility or other factors was disregarded. Contrast-enhanced magnetic resonance imaging was performed in all patients before and after UFE, and the size of PVA particles used was 255-700 µm. Results: Among 94 patients who underwent UFE with PVA, 74 were on contraceptives, 6 had been single until the point of interview, and 8 were lost to follow-up. Of the remaining 6 patients who desired future pregnancy, 5 (83%) succeeded in becoming pregnant (1 patient became pregnant twice). Of a total of 8 pregnancies, 6 were planned pregnancies and 2 occurred after contraception failed. Five deliveries were vaginal, and 2 were by elective cesarean. Artificial abortion was performed in 1 case of unplanned pregnancy. There was 1 case of premature rupture of membrane (PROM) followed by preterm labor and delivery of an infant who was small-for-gestational-age. After UFE, mean volume reduction rates of the uterus and fibroid were 36.6% (range 0 to 62.6%) and 69.3% (range 36.3% to 93.3%), respectively. Conclusions: Although the absolute number of cases was small, UFE with PVA particles ultimately did not affect fertility in the women who underwent the procedure. [ABSTRACT FROM AUTHOR]

The aim of this study was to describe the intrahepatic hemodynamic modifications induced by right portal vein embolization (RPVE) using Doppler ultrasound. Eighteen patients with hepatocellular carcinoma (n = 8), liver metastases (n = 9), or multiple adenomas, underwent RPVE 1 month before right hepatectomy in order to increase the size of future remnant liver. Doppler ultrasound was performed before and 1 month after RPVE. The portal vein flow and the hepatic artery resistive index in right and left lobes (segments V and III) were calculated. We recorded simultaneously artery and portal vein of segment III to measure the arterioportal ratio calculated as follows: (maximal arterial systolic velocity minus maximal portal vein velocity)/maximal arterial systolic velocity. Results were compared in cirrhotic patients (group A) and in healthy liver patients (group B). In both groups, portal flow was not significantly modified following RPVE. In the left lobe, in both groups the hepatic artery resistive index was not significantly modified. In group B, the arterioportal ratio decreased significantly (0.71 ± 0.18 and 0.42 ± 0.23, respectively, before and after embolization; p < 0.01), whereas it was not statistically modified in group A (0.75 ± 0.17 and 0.69 ± 0.14, respectively, before and after embolization). The right hepatic arterial resistive index decreased significantly in both groups after embolization (0.74 ± 0.07 to 0.66 ± 0.07, p < 0.05; and 0.66 ± 0.07 to 0.61 ± 0.06, p < 0.05, respectively, before and after RPVE for groups A and B). Total portal flow was unchanged after RPVE (750 ± 337 ml/mn and 696 ± 231 ml/mn, respectively, before and after RPVE). The hepatic artery resistive index was unchanged before and after embolization in the left lobe (0.75 ± 0.13 and 0.74 ± 0.14, respectively), but significantly decreased in the right lobe (0.7 ± 0.08 and 0.62 ± 0.06 respectively, p < 0.05). The left arterioportal ratio decreased significantly from 0.76 ± 0.17 to 0.52 ± 0.23 after PVE, p < 0.02). Our study confirms that right portal occlusion induces a decrease in hepatic artery resistive index in the right lobe and does not modify total portal flow. The left and right lobes of the liver have separate arterioportal regulation. [ABSTRACT FROM AUTHOR]

Surgical treatment of carcinoma of the distal third of the rectum with anal sphincter preservation is increasingly used in accredited cancer centers. This study aimed to evaluate the diagnostic usefulness of radiological investigations in the management of patients who had undergone resection with coloanal anastomosis for carcinoma of the rectum, in the immediate post-operative period, during closure of the protective colostomy and in the follow-up of symptomatic recanalized patients. A total of 175 patients who had undergone total rectal resection with end-to-side anastomosis for carcinoma of the distal third of the rectal ampulla, most of whom had received postoperative radiotherapy, were evaluated radiologically. In the postoperative period radiological investigation was ordered only for symptomatic patients to detect pathology of the anastomosis and the pouch sutures and was used direct film abdominal radiography and contrast-enhanced radiography of the rectal stump with a water-soluble radio-opaque agent. Before closure of the colostomy, 2 months after rectal excision or approximately 4 months after if postoperative radiotherapy was given, the anastomosis and pouch of all patients, even asymptomatic ones, were studied with water-soluble contrast enema to check for normal canalization. In the follow-up after recanalization radiological examinations were done to complete the study of the large intestine if the endoscopist was not able to examine it up to the cecum. Of the 175 patients examined radiologically during the postoperative period and/or subsequent follow-up, 95 showed no pathological findings. Seventy-nine patients had fistulas of the coloanal anastomosis or the pouch, 23 of which supplied a presacral collection. In the absence of severe sepsis, the only therapeutic measures were systemic antibiotics and washing of the surgical catheters to maintain efficient operation. In 2 patients in whom transanal drainage was performed radiologically the fistula was cured in 1 week. In 36 cases of cicatricial stenosis, 17 at the coloanal anastomosis and 19 at the pouch, radiological examination always detected the lesion, correctly defining its anatomical characteristics, nature and extension. Of the 19 cases of stenosis treated radiologically, 15 recovered an adequate intestinal calibre for normal evacuation. During follow-up of the 175 patients operated on, 21 cases of recurrence were detected. Radiological examination was requested as the first investigation in only one of these cases, for a patient with subocclusion. Radiological investigations in patients who have undergone coloanal anastomosis are of real diagnostic value in the immediate post-operative period, during closure of the protective colostomy and in the follow-up of symptomatic recanalized patients. [ABSTRACT FROM AUTHOR]

Purpose: The treatment of inoperable tracheobronchial stenoses with Palmaz stents is analyzed in terms of the clinical effect, typical complications, and long-term follow-up.Methods: Twenty-seven Palmaz stents were placed in 22 patients with the help of a rigid bronchoscope.Results: Stents were implanted in the distal trachea, the main bronchi, and the lower lobe bronchi. Twenty-one of 22 patients reported an immediate subjective improvement in their respiratory situation. The mean survival time was 12 months; in two patients the stents were well tolerated for up to 40 months. A redilation of three stents was successful up to 33 months. In three cases a dislocation of the stent was observed; after bronchoscopic retraction a new stent was successfully implanted in each case. CONCLUSIONoff Treatment of inoperable tracheobronchial stenoses with the Palmaz stent is a safe procedure that provides an immediate improvement of the patient's pulmonary situation. The Palmaz stent shows a minimal complication rate in the long-term follow-up. [ABSTRACT FROM AUTHOR]

The objective of this study was to prove the principle of CT-guided gene therapy by intratumoral injection of a tumor suppressor gene as an alternative treatment approach of incurable non-small-cell lung cancer. In a prospective clinical phase I trial six patients with non-small-cell lung cancer and a mutation of the tumor suppressor gene p53 were treated by CT-guided intratumoral gene therapy. Ten milliliters of a vector solution (replication-defective adenovirus with complete wild-type p53 cDNA) were injected under CT guidance. In four cases the vector solution was completely applied to the tumor center, whereas in two cases 2 ml aliquots were injected into different tumor areas. For the procedure the scan room had been approved as a biosafety cabinet. Gene transfer was assessed by reverse transcription and polymerase chain reaction in biopsy specimens obtained under CT guidance 24-48 h after therapy. Potential therapeutic efficacy was evaluated on day 28 after treatment using spiral CT. The CT-guided gene therapy was easily performed in all six patients without intervention-related complications. Besides flu-like symptoms, no significant adverse effects of gene therapy were noted. Three of the four patients with central injection exhibited gene transfer in the posttreatment biopsy. Gene transfer could not be proven in the two patients with multiple 2 ml injections. After 28 days, four of the six patients showed stable disease at the treated tumor site, whereas other tumor manifestations progressed. Computed tomography-guided injections are an adequate and easy-to-perform procedure for intratumoral gene therapy. [ABSTRACT FROM AUTHOR]

Pelvic bone injuries are infrequent complications of radiotherapy. However, insufficiency fractures in irradiated pelvic bones may be underdetected, particularly in postmenopausal women. We describe the clinical presentation, radiologic evaluation, and course of disease in three patients with postradiation pelvic insufficiency fractures. Differential diagnosis included metastatic disease, tumor recurrence, and second malignancy. Recognition of radiographic features may prevent unnecessary, possibly morbid treatments. [ABSTRACT FROM AUTHOR]

Thirteen stenotic infrainguinal arterial bypasses (12 venous, 1 Gore-tex graft) were treated by transluminal angioplasty, either percutaneously (10 patients) or surgically (3 patients). Eleven procedures were immediately successful (two at the proximal portions of femoropopliteal grafts, six near the distal anastomoses, and three at the distal parts of femoroinfrapopliteal grafts) and dilated stenoses are still patent with a mean duration of 24 months in all patients except 2 who died during the follow-up period. The calculated cumulative patency rate is 85% at 36 months. Two procedures were followed by immediate disruption near the distal end of an in situ saphenous bypass graft where balloon inflation was performed. These required immediate surgical repair. Dilatation of the distal ends of in situ saphenous femoropopliteal bypasses may not be as safe as in other locations. [ABSTRACT FROM AUTHOR]

An algorithm for correction of the geometrical distortion in digital subtraction angiography (DSA) images was developed. Originally invented for 3D X-ray angiography, the algorithm was implemented in a computer program designed to fulfil the specific needs of stereotaxic DSA. The algorithm is based on transformation of an image of a grid from a distorted image back into its original pattern. The same transformation is then applied pixel-by-pixel to the angiographic images, which are acquired in direct conjunction with the grid image, without moving the gantry. The algorithm was tested in phantom studies and in the clinical situation with seven patients in ten examinations. Comparisons were made between co-ordinate determinations made on conventional full-size cut film and those performed on uncorrected and corrected DSA images, using 30- and 23-cm fields of view. With our method of measurement we could not show any remaining geometric distortion in the corrected DSA images. This distortion correction can, if properly applied, be used for high-precision stereotaxic DSA. [ABSTRACT FROM AUTHOR]

We report a case of alveolar soft part sarcoma (ASPS) of the thigh with lung metastases in a 22-year-old woman. The findings of digital subtraction angiography (DSA) and MRI contributed to the diagnosis of ASPS. Especially dynamic contrast-enhanced MRI was useful for evaluating the effect of chemoembolotherapy. [ABSTRACT FROM AUTHOR]

The prognostic value of histologic or cytologic features were examined in 317 patients with an astrocytic glioma. Of 46 features examined 7 morphologic characteristics of nucleus and 5 of mesenchyma correlated well with grading according to Kernohan. The morphological characteristics of nucleus are cellularity, atypical nuclei, polymorphism, multinucleated cells, hyperchromasia, gigantic nuclei and mitosis. For mesenchyma these were vascularity, vascular endothelial proliferation, vascular glomeruli, necrosis with palisade formation and necrosis without palisade formation. Scoring of these items on a scale from 0 to 4 enables us to establish a nucleus-score (max. 28) and a mesenchyma-score (max. 20). Nucleus-score + mesenchyma-score ≤ 10 corresponds with astrocytoma grade II, ≤ 20 with grade III and > 20 with grade IV. A low nucleus-score in grade II (< 5) predicts a long survival (> 10 years), a high nucleus-score a low survival (median 0.6 year). In grade III a low mesenchyma-score predicts a median survival of 1.25 years, a high mesenchyma-score a median survival of 0.38 year. This retrospective study shows that nucleus-score and mesenchyma-score correlate to grading according to Kernohan and are highly correlative to survival. [ABSTRACT FROM AUTHOR]

We report a case of life-threatening esophageal hemorrhage after metal stent implantation successfully treated by arterial embolization. An 85-year-old woman was admitted in shock secondary to massive hematemesis and melena. Recent medical history revealed esophageal cancer treated 8 weeks previously by endoesophageal radiotherapy (40 Gy) and endoscopic placement of a covered Wall-stent prosthesis. Selective arteriography of the fifth posterior right intercostal artery showed massive contrast extravasation in the esophagus. Embolization was performed with 150-250-micron polyvinyl alcohol particles. Follow-up at 5 months was uneventful. Arteriography and embolization are advised when severe hemorrhage occurs after esophageal implantation of metal stents. [ABSTRACT FROM AUTHOR]